​​Newsflash: You don't have to give birth at a hospital just because "that's what everybody does." I highly encourage you to explore all of the available options and let go of other people's fears and expectations. Ask yourself what you want and which place will get you there.

𝐇𝐎𝐌𝐄
If you and baby are healthy and you wish to go unmedicated and avoid unnecessary interventions, this is the place for you! Labor flows as it's meant to under the care of a midwife who will not push routine procedures or a deadline. Here you will find the most comfort (and patience) and can give birth in a tub or in any room or position you prefer. You will likely also have the same personal care team you had during prenatal appointments. Don't be so quick to dismiss this option if you catch yourself saying, "I really want a home birth, but what if something goes wrong?" This question requires a deeper dive with a professional.
Think a home birth isn't for you? Think again!

𝐇𝐎𝐒𝐏𝐈𝐓𝐀𝐋
If you are anticipating an issue that requires medical intervention/specialized care or you know you want an epidural, the hospital is for you. Here, you can count on the most advanced technology and doctors skilled in labor management. If you're hoping to go unmedicated at a hospital or decline routine interventions, you will need to do some extra work to get your wishes. If the hospital has a tub, you might not be allowed to give birth in it. You will likely labor with many nurses and providers (OB or midwife) you don't know.

𝐁𝐈𝐑𝐓𝐇 𝐂𝐄𝐍𝐓𝐄𝐑
The best of both worlds! This location is NOT at a hospital. It has the creature comforts of home with just a few more pieces of equipment than a home birth. You will labor as if you were home but won't have to deal with the logistics of planning a home birth. Here, you'll give birth with a midwife and the nurses on shift.
𝐇𝐎𝐏𝐒𝐈𝐓𝐀𝐋 𝐁𝐈𝐑𝐓𝐇 𝐂𝐄𝐍𝐓𝐄𝐑
While it's called a birth center, it'll likely still follow hospital policies and give you access to pain meds and an OR. However, the rooms are often more comfortable and you'll probably be cared for by midwives.

​Hear me out just a moment while I step on my soapbox!

I want to talk about Group B Strep (GBS) testing and its management in labor. I'm not here to tell you what to do, but I want to tell you what you 𝒄𝒂𝒏 do.

The typical management in the US is to get tested around 36 weeks and if you test positive you are told to immediately go into the hospital to receive IV antibiotics every four hours until the baby is born. Some providers ask you to come when your water has broken and others, before your water breaks. Why could this be an issue? Well, lean in and learn:

𝟭. Coming into the hospital early could severely alter your plans (the environment can affect the flow of labor and put you at a greater risk of more interventions).
𝟮. Prolonged use of IV fluids could affect breastfeeding.
𝟯. You're killing the bad AND good bacteria in your system which also affects the baby's microbiome.
𝟰. About 30% of pregnant women have GBS and that doesn't inherently mean it's a bad thing. We're all made of bacteria. The issue is whether your baby gets exposed, colonized, and infected. Not all of those three things happen in labor.
𝟱. GBS is a transient bacteria, meaning that if you were positive 4 weeks ago you might not be when you go into labor. In other words, you are possibly treating a problem you might not have. Also, the test isn't 100% accurate, and testing negative could be a false result and you'll labor with an unknown positive diagnosis.

Why are you doing all this? For the 1-2% chance your baby will get infected. Meaning 98% of you will be unnecessarily treated like there will be an issue. The math ain't mathing on this one. But labor care in this country is all about treating a problem before it becomes a problem. I'm not trying to discredit the real effect GBS can have on a baby. I'm just laying out the numbers.

But I do understand if some of you aren't even willing to take that small risk, don't want to defy provider recommendations, or just want to know if you have other options. I'm not here to tell you what's right or wrong, but I want to encourage YOU to call the shots knowing what the risks/benefits and options are.

👉Agree to antibiotics if you get a fever, premature labor, or your water has been broken for 18+ hours.
👉Agree to go to the hospital and get antibiotics only after labor is well-established. Studies have shown that at least one round of antibiotics 2-4 hours before the baby is born can still greatly reduce the chances of infection.
👉Decline vaginal exams that can increase the chances of infection.
👉Decline antibiotics and testing and treat the newborn if there are signs of infection. This is the usual approach in the UK.
👉Ask for a quick screening GBS test in labor instead of the standard one in pregnancy.

Read  more at Evidence Based Birth

You may not know this, but I'm also a spin instructor. I've been spinning for more than 10 years and I'm so passionate about it! Turns out, a lot of what I teach and practice during my classes perfectly applies to unmedicated labor. Think about it. A one-hour spin class is a huge physical feat that can seem daunting, yet other people can achieve it. Some even come back for more! They sweat, let go of inhibitions, push themselves past their known limit, go inward, connect with their breath, and feel euphoric when done. You might wonder what those athletes have that you don't.

Want to know the secret? It's peak performance! When you activate the parasympathetic nervous system, you tap into your peak performance.

Inductions are pretty commonplace here in the States (about 25% of labors are induced), but that doesn't mean you are just a number, too. You can definitely come in prepared and make the most of this experience.
​
I'd also like to mention that time can sometimes feel like the enemy during inductions. If you're "stuck" at 3 cm after 6 hours, it might seem like you'll be doing this for-e-ver and the induction might be deemed failed or the hospital might make you feel rushed, but remember that many pregnant people are (sometimes unknowingly) at 3 cm for up to a week and no one even bats an eye at that. The fact that you have to sit and watch the clock between four white walls makes time seem cruel. Trust that if others can take their time at 3 cm, so can you!

The following info applies to labors with no complications to the laboring person or the baby.

Simple things can make a huge difference in improving your labor experience. 

​When we know better, we do better!
​
Bonus: Not sleeping or resting in the beginning of labor, especially if you're being induced.

When it comes to labor prep you know to get your body ready for the big day. You will practice yoga, find a breathing technique that works for you, fuel your body with the right food, and become mindful of your body's mechanics. But did you know the most important work in labor is mental?

The deepest work you will do in labor is emotional, mental, and spiritual. You will need to surrender to the great mystery that is childbirth. You will not know how or when baby will come. You will need to give up any time limits, expectations, and control to go deep within yourself and labor peacefully. Labor is not a time for holding back our primal instincts or allowing fear to hold us back. It's a time of surrender and acceptance.

Maybe the hospital amenities or sense of safety have drawn you in. Or maybe you can't imagine delivering without your rock star team. Or maybe hospital births are just the way things are done. Whatever the reason, I'm sure you want to make it the best possible experience and avoid any unnecessary interventions. 

BEFORE YOU GO
•Read up on your hospital's policies and discuss the ones you aren't comfortable with to try and find a compromise or alternative with your care team.
•Tour the hospital and learn how to enter the labor and delivery department (after hours, too). Find out what the in-processing procedure looks like, what you can sign ahead of time, and what is done during triage. Ask what signs you need to show before being admitted.

Sometimes the amount of info out there regarding VBAC can be overwhelming, confusing, and at times plain false! It can be tricky navigating through all that noise, so I've narrowed it down for you. Read on to learn how YOU can stay informed and in control of your care.

Your provider is a key person in the success of your VBAC and it's very important to find someone who is supportive, not just tolerant. Remember that yes, no one can legally force you to have a C-section nor deny you care even if the hospital has a VBAC ban, but it's also important to know ahead of time if your hospital has the tools and staff to support a true C-section emergency. You really can't force a hospital to treat you if they don't have the means. And if your provider is suggesting a repeat C-section, don't dismiss the advice so quickly. Really talk to them about their concerns to find solutions and compromises. Sometimes having a repeat C-section is truly medically necessary and your best option.

Next time you see your provider ask:
•How long will you allow me to remain pregnant? Why do you prefer that date?
•Will we attempt an induction? Which methods will be used?
•How will I be monitored during labor?
•How do you feel about me laboring as long as possible as long baby and I are doing well?
•At what point during labor will a C-section be needed?

Also, ask yourself:​

So, maybe you are new to this doula thing or all of your friends have gotten one for their labors and swear they couldn't have done it without the help of a doula. Now you're wondering if you should get one too. I mean, all the cool kids are doing it, right?

Even though I'd love your business, I'm not going to lie to you. Doulas aren't the only ones who can improve your birth experience. I say it all the time, surround yourself with the RIGHT people! Studies have shown that having doula support during pregnancy and labor can decrease your chances of a C-section, need for pain medication, and assisted delivery. We can also increase your overall satisfaction with your birth experience and improve breastfeeding and bonding outcomes. But how does a doula have that effect and can anyone else give you those amazing outcomes?

When choosing a provider, remember that YOU are the customer and you have choices. If you're not vibing with your provider, move on and find someone who will support you.

Be honest with your doctor and tell them there are a few important questions you'd like to ask. If they don't even take the time to hear you out then that's your sign to find someone else. It's best to know early on if they're a good match for your labor experience. Keep in mind that there is no labor police and you have total autonomy over your body and baby's. Provider preference/recommendation is not law and you have the right to choose what feels right to you, even if it's outside of the norm.

If you truly have no say about which provider you get and you're not quite comfortable with them, consider switching to a midwife, a home birth, laboring as long as possible at home, or having a rockstar support partner with you at the hospital.

QUESTIONS TO CONSIDER WHEN CHOOSING A PROVIDER:

-Do you support unmedicated births and what are your views on them?
-How do you support medicated births and what are your views on them?
-Do you support breech births, how?
-Who are your backups and will I meet them?
-How do you feel about doulas?
-How do you feel about birth plans?
-What are your induction and C-section rates?
-Do you support a VBAC and how do you ensure it'll be as successful as possible?
-How do you view pain during labor?
-What is your plan if I go past my due date?
-How many hours will you allow me to labor after my water breaks?
-How long will you allow the umbilical cord to remain attached?
-Will you administer Pitocin to deliver the placenta?

Remember that if you choose an OB you will likely only labor with them for a short while, as they tend to cover multiple births at a time. Still, knowing ahead of time how they can support you during the expected and unexpected can help you decide who better aligns with your wishes. 
For an even better experience, choose your hospital wisely and get support from a doula, or make sure you and your birth partner are well-educated and able to make decisions during complex situations.